|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 60687064011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna American Axle |
$2.41
|
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.41
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Advantage |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.78
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.78
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 67877015901
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.05
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 62756014201
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna American Axle |
$123.73
|
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Advantage |
$133.25
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health SBD |
$119.92
|
| Rate for Payer: UMR Bronson Commercial |
$83.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 49483062301
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 60687064011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna American Axle |
$2.41
|
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.41
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Advantage |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.78
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$1.93
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.78
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 62756014201
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna American Axle |
$123.73
|
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Medicare |
$95.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Advantage |
$133.25
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health SBD |
$119.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.73
|
| Rate for Payer: UHC Core |
$99.17
|
| Rate for Payer: UHC Exchange |
$74.81
|
| Rate for Payer: UMR Bronson Commercial |
$70.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 67877015901
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
NDC 60687064001
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna American Axle |
$240.82
|
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.82
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Advantage |
$259.35
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: Priority Health SBD |
$233.41
|
| Rate for Payer: UMR Bronson Commercial |
$163.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 49483062301
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.16
|
| Rate for Payer: UHC Core |
$51.42
|
| Rate for Payer: UHC Exchange |
$38.79
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 67877041301
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Advantage |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 50268055111
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna American Axle |
$2.39
|
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Core |
$1.91
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 67877041401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$63.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$194.75
|
|
|
Service Code
|
NDC 51224010750
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UMR Bronson Commercial |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 49483062401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UMR Bronson Commercial |
$63.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$183.35
|
|
|
Service Code
|
NDC 50268055115
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$165.01 |
| Rate for Payer: Aetna American Axle |
$119.18
|
| Rate for Payer: Aetna Commercial |
$155.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.18
|
| Rate for Payer: Cash Price |
$146.68
|
| Rate for Payer: Cofinity Advantage |
$128.34
|
| Rate for Payer: Cofinity Commercial |
$157.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.68
|
| Rate for Payer: Healthscope Commercial |
$165.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.51
|
| Rate for Payer: PHP Commercial |
$155.85
|
| Rate for Payer: Priority Health SBD |
$115.51
|
| Rate for Payer: UMR Bronson Commercial |
$80.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 67877041401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$71.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.18
|
| Rate for Payer: UHC Core |
$74.69
|
| Rate for Payer: UHC Exchange |
$56.34
|
| Rate for Payer: UMR Bronson Commercial |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 49483062401
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna American Axle |
$93.18
|
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$71.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.18
|
| Rate for Payer: UHC Core |
$74.69
|
| Rate for Payer: UHC Exchange |
$56.34
|
| Rate for Payer: UMR Bronson Commercial |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$183.35
|
|
|
Service Code
|
NDC 50268055115
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.84 |
| Max. Negotiated Rate |
$165.01 |
| Rate for Payer: Aetna American Axle |
$119.18
|
| Rate for Payer: Aetna Commercial |
$155.85
|
| Rate for Payer: Aetna Medicare |
$91.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.18
|
| Rate for Payer: BCBS Complete |
$73.34
|
| Rate for Payer: Cash Price |
$146.68
|
| Rate for Payer: Cofinity Advantage |
$128.34
|
| Rate for Payer: Cofinity Commercial |
$157.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.68
|
| Rate for Payer: Healthscope Commercial |
$165.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.51
|
| Rate for Payer: PHP Commercial |
$155.85
|
| Rate for Payer: Priority Health SBD |
$115.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.18
|
| Rate for Payer: UHC Core |
$95.53
|
| Rate for Payer: UHC Exchange |
$72.06
|
| Rate for Payer: UMR Bronson Commercial |
$67.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.51
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$194.75
|
|
|
Service Code
|
NDC 51224010750
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.06 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna American Axle |
$126.59
|
| Rate for Payer: Aetna Commercial |
$165.54
|
| Rate for Payer: Aetna Medicare |
$97.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.59
|
| Rate for Payer: BCBS Complete |
$77.90
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Cofinity Advantage |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.80
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.06
|
| Rate for Payer: PHP Commercial |
$165.54
|
| Rate for Payer: Priority Health SBD |
$122.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.59
|
| Rate for Payer: UHC Core |
$101.46
|
| Rate for Payer: UHC Exchange |
$76.54
|
| Rate for Payer: UMR Bronson Commercial |
$72.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.06
|
|
|
METFORMIN ER 750 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 50268055111
|
| Hospital Charge Code |
35771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna American Axle |
$2.39
|
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Advantage |
$2.57
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
IP
|
$313.14
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.78 |
| Max. Negotiated Rate |
$281.83 |
| Rate for Payer: Aetna American Axle |
$203.54
|
| Rate for Payer: Aetna Commercial |
$266.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.54
|
| Rate for Payer: Cash Price |
$250.51
|
| Rate for Payer: Cofinity Advantage |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$269.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.51
|
| Rate for Payer: Healthscope Commercial |
$281.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.85
|
| Rate for Payer: PHP Commercial |
$266.17
|
| Rate for Payer: Priority Health SBD |
$197.28
|
| Rate for Payer: UMR Bronson Commercial |
$137.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.85
|
|
|
METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION
|
Facility
|
OP
|
$313.14
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$281.83 |
| Rate for Payer: Aetna American Axle |
$203.54
|
| Rate for Payer: Aetna Commercial |
$266.17
|
| Rate for Payer: Aetna Medicare |
$156.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.54
|
| Rate for Payer: BCBS Complete |
$125.26
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$250.51
|
| Rate for Payer: Cash Price |
$250.51
|
| Rate for Payer: Cofinity Advantage |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$269.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.51
|
| Rate for Payer: Healthscope Commercial |
$281.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.85
|
| Rate for Payer: PHP Commercial |
$266.17
|
| Rate for Payer: Priority Health SBD |
$197.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$3.14
|
| Rate for Payer: UHC Exchange |
$3.14
|
| Rate for Payer: UMR Bronson Commercial |
$115.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.85
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,427.80
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$628.23 |
| Max. Negotiated Rate |
$1,285.02 |
| Rate for Payer: Aetna American Axle |
$928.07
|
| Rate for Payer: Aetna American Axle |
$1,419.99
|
| Rate for Payer: Aetna Commercial |
$1,213.63
|
| Rate for Payer: Aetna Commercial |
$1,856.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,419.99
|
| Rate for Payer: Cash Price |
$1,142.24
|
| Rate for Payer: Cash Price |
$1,747.68
|
| Rate for Payer: Cofinity Advantage |
$1,529.22
|
| Rate for Payer: Cofinity Advantage |
$999.46
|
| Rate for Payer: Cofinity Commercial |
$1,878.76
|
| Rate for Payer: Cofinity Commercial |
$1,227.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.68
|
| Rate for Payer: Healthscope Commercial |
$1,285.02
|
| Rate for Payer: Healthscope Commercial |
$1,966.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,529.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,638.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,213.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,070.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,638.45
|
| Rate for Payer: PHP Commercial |
$1,213.63
|
| Rate for Payer: PHP Commercial |
$1,856.91
|
| Rate for Payer: Priority Health SBD |
$1,376.30
|
| Rate for Payer: Priority Health SBD |
$899.51
|
| Rate for Payer: UMR Bronson Commercial |
$628.23
|
| Rate for Payer: UMR Bronson Commercial |
$961.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,638.45
|
|
|
METHADONE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,427.80
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
10546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$1,285.02 |
| Rate for Payer: Aetna American Axle |
$928.07
|
| Rate for Payer: Aetna American Axle |
$1,419.99
|
| Rate for Payer: Aetna Commercial |
$1,213.63
|
| Rate for Payer: Aetna Commercial |
$1,856.91
|
| Rate for Payer: Aetna Medicare |
$713.90
|
| Rate for Payer: Aetna Medicare |
$1,092.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,419.99
|
| Rate for Payer: BCBS Complete |
$873.84
|
| Rate for Payer: BCBS Complete |
$571.12
|
| Rate for Payer: BCBS Trust/PPO |
$57.38
|
| Rate for Payer: BCBS Trust/PPO |
$57.38
|
| Rate for Payer: BCN Commercial |
$57.38
|
| Rate for Payer: BCN Commercial |
$57.38
|
| Rate for Payer: Cash Price |
$1,142.24
|
| Rate for Payer: Cash Price |
$1,747.68
|
| Rate for Payer: Cash Price |
$1,142.24
|
| Rate for Payer: Cash Price |
$1,747.68
|
| Rate for Payer: Cofinity Advantage |
$999.46
|
| Rate for Payer: Cofinity Advantage |
$1,529.22
|
| Rate for Payer: Cofinity Commercial |
$1,227.91
|
| Rate for Payer: Cofinity Commercial |
$1,878.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.68
|
| Rate for Payer: Healthscope Commercial |
$1,285.02
|
| Rate for Payer: Healthscope Commercial |
$1,966.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,529.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,638.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,142.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,747.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,213.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,856.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,638.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,070.85
|
| Rate for Payer: PHP Commercial |
$1,213.63
|
| Rate for Payer: PHP Commercial |
$1,856.91
|
| Rate for Payer: Priority Health SBD |
$899.51
|
| Rate for Payer: Priority Health SBD |
$1,376.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.21
|
| Rate for Payer: UHC Core |
$29.21
|
| Rate for Payer: UHC Core |
$29.21
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$528.29
|
| Rate for Payer: UMR Bronson Commercial |
$808.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,638.45
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
NDC 09900001004
|
| Hospital Charge Code |
15996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.32
|
| Rate for Payer: Cofinity Advantage |
$1.16
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$1.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.04
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.24
|
|
